This Earth Day be a Champion for Environmental Science

Did you know that doctors are among the most trusted professionals in this country, specifically with regard to information about climate change? Environmental factors are hurting the health of millions of Americans every day and yet there is still a considerable lack of awareness about the harmful effects of things like extreme weather events, air pollution and other toxins.

As Earth Day approaches, it seems fitting that this year’s campaign is focused on environmental and climate literacy because it reminds us as ob-gyns how important it is for us to participate in the effort by leveraging the trust our patients have in us.  Our partner organization, the International Federation of Gynecology and Obstetrics, has kicked off the week by launching a social media awareness campaign around Earth Day.  You can follow them on Twitter under the handle @FIGOHQ.

Last month, I spoke at the launch of the Medical Society Consortium on Climate Change and Health that has brought together ten associations representing nearly 500,000 physicians, including ACOG, to help increase awareness among the public and policymakers about the negative health effects of climate change on Americans. During my talk, I spoke about the fact that women face some of the greatest risks from climate change over the course of their lives, and especially during pregnancy. In affected regions, climate change puts women at risk of disease, malnutrition, poor mental health, lack of reproductive control, and even death. Additionally, women’s exposure to toxic environmental agents during the preconception and prenatal stages can have a profound and lasting effect on obstetrical and later life outcomes, including increased risk of birth defects and childhood cancer.

In 2016, ACOG adopted a policy which recognizes that climate change is an urgent women’s health concern and a major public health challenge endangering fetal health. In fact, we discover new evidence every day of how it can disturb fetal development. A recent NIH study found that exposure to extreme hot and cold temperatures during pregnancy leads to increased risk of low birth weight in infants.

While the connection between climate change and women’s health may not at first seem obvious, there are a number of ways it directly impacts women’s health.  You can look at them in several categories: a healthy pregnancy starts with clean air, clean water, no toxic chemicals, and stable climate.

Air pollution poses serious risks for women’s health.  It is linked to pregnancy loss, low birth weight babies, and preterm delivery.  Fine particle air pollution affects the placenta in pregnancy, and can interfere with fetal brain development.  Ambient and household air pollution result in 7 million deaths globally per year; these effects are worse in low-resource areas.

Heavy downpours and flooding mixed with high temperatures can spread bacteria, viruses, and chemicals that lead to contaminated food and water. This results in higher levels of methylmercury in fish and shellfish, a known cause of birth defects.

Increased use of pesticides can interfere with the developmental stages of female reproductive functions, including puberty, menstruation and ovulation, menopause, fertility, and the ability to reproduce multiple offspring. These toxic exposures also affect fetal brain development, and contribute to learning, behavioral, or intellectual impairment, as well as neurodevelopmental disorders such as ADHD and autism spectrum disorder.

Extreme temperatures have fostered increases in the number and geographic range of insects. For example, Zika-carrying mosquitos have led to more than 1,500 infections in pregnant women across the United States and District of Columbia, and more than 3,200 infections in Puerto Rico and U.S. territories. Furthermore, extreme heat during pregnancy is tied to a 31 percent increase in low birthweight babies less than 5.5 pounds.

Unfortunately, in many cases, underserved and vulnerable populations are disproportionately affected by climate change. This includes individuals living in poverty, exposed to toxic materials via their occupation, who lack nutritious food, and live in low quality housing. That’s why access to health care is so critical.

We don’t all have to be experts in environmental science, but we all need to support rigorous scientific investigation into the effects of climate change and toxic environmental agents. With evidence to support us, ob-gyns must be the authoritative voice and help to ensure that the discussion on climate change includes protecting the health and safety of all women and children.

This blog post was co-authored by Nathaniel DeNicola, MD, MSHP, the ACOG liaison to the American Academy of Pediatrics Executive Council on Environmental Health, and social media director for the International Federation of Gynecology and Obstetrics Working Group on Reproductive and Developmental Environmental Health.

Four Ways ACOG Has Impacted Global Women’s Health in Just the Past Year

In 1994, my wife and I arrived for our first two-week mission in the Dominican Republic and were stunned by the line of people waiting outside of the hospital for us. Since medical school more than a decade earlier, we had dreamed of participating in mission projects around the world to help women in dire need of basic medical care. But then my wife began her career as a nurse, we started our family, and after residency I went into private practice. So, that goal went by the wayside. However, our trip to the Dominican Republic quickly reignited our hopes of providing necessary ob-gyn services in low resource settings. Living in the United States, it’s easy to forget that many countries around the world are battling poverty and disease and don’t have the same infrastructure and safety nets we do. After that first trip, I came home to a fully equipped operating room with the proper tools and lights that worked, my wife didn’t have to hold a flashlight during surgery because the power was out. We had carpeting and hot water at home. From that point on, my eyes were opened.

Since that first trip, I’ve continued to travel and offer my services to advance health care in struggling countries. This work has taught me that we can really make a difference in global women’s health by sharing our knowledge and resources as ob-gyns. As my presidential term at ACOG comes to a close, it is an appropriate time to reflect on what we have accomplished from my six-point plan, developed over a year ago, to help improve the health of women and children worldwide, with a focus on training and providing health care around the world.

The first step was to make these kinds of missions more easily identified and attainable. While it’s often not realistic to leave your practice for months; two weeks is doable. That’s why we developed a listing or database of non-profit organizations involved in two-week mission work in which some of our members had participated. Now on the ACOG website there is a global health resource center. ACOG members can discover more information about each organization, check these organizations’ calendars for potential projects, talk with ACOG fellows and junior fellows who have done projects, and sign up. And we must continue to get the word out so more members use and add to the database.

In partnership with the U.S. Department of Health and Human Services, we’ve also formed and grown the Alliance for Innovation in Maternal Health (AIM), which creates instructional and educational portfolios, or “safety bundles,” to fight high rates of maternal mortality in the United States and now Malawi. Women living in rural areas of Malawi give birth at community health centers that can’t perform operative vaginal deliveries or C-sections. When these situations arise or other complications occur, women are transferred to the central hospital in the city, most often without any attempts at stabilization prior to transport. They are often in poor condition when they arrive, which results in many otherwise preventable maternal deaths. The AIM postpartum hemorrhage bundle has been instituted into practice at both the community health clinic and referral hospital. To date, more than 130 local people have participated in vital simulations to help these patients. And while we do not have formal data on the program yet, we know that several women have received life-saving care because the teams were able to communicate and execute care in a way that they didn’t before. We anticipate many more successes that will hopefully mirror the kinds of gains we have seen here in the United States.

In addition, last year ACOG partnered with Health Volunteers Overseas, a nonprofit group that helps educate and train local health providers in underdeveloped countries in various areas of obstetrics and gynecology. It begins with local providers telling us what they need and then we come up with a plan and work together to make it happen. As of today, we have completed four site assessments and will begin offering global service opportunities for fellows in the four countries by May 2017.

Lastly, in Ethiopia, we received a five-year grant to develop a plan in partnership with the Ethiopian Society of Obstetricians and Gynecologists to strengthen their ob-gyn residency training programs and curriculum, improve continuing medical education, support the publishing and accessibility of clinical outcomes research, and develop an ob-gyn examination and certification program. Since its inception, the program has made great strides by working “shoulder-to-shoulder” with the Ethiopians. As a result of this program, there is now interest from other African countries to begin the same program.

The bottom line is, many women around the world are lacking access to quality, evidence-based health care and they are paying the price with their lives. As ob-gyns, we have the power to prevent this by using our skills to help reduce global maternal morbidity and mortality, as well as improved quality of life. These programs are a prime example of how we can achieve that by dedicating some of our time and effort to a cause that is greater than ourselves. While we’ve accomplished a lot, we still have much to do. So, even if you aren’t sure you have the time, consider any way you can contribute. Believe me, it will make a difference.

It’s Time We Talk About Endometriosis

Endometriosis—when the uterine lining grows outside of the uterus, resulting in severe pain, swelling and bleeding—is thought to affect more than 11 percent of all American women between the ages of 15 and 44. This condition impacts 6.5 million U.S. women, and 176 million women worldwide. Yet, it is still not easily recognized. It takes about 10 years from when women experience their first symptoms to receive an endometriosis diagnosis—half that time to recognize and bring up symptoms to a doctor and the other half for the doctor to diagnose it. For Endometriosis Awareness Month this March, we as obstetrician-gynecologists must do our part to raise awareness about the condition with our patients, strive to improve our understanding of the disease, and ensure more timely and accurate diagnoses.

Improving awareness and timely diagnosis of endometriosis helps women avoid unnecessary pain, and decrease infertility rates. Around 40 percent of all women with infertility have endometriosis and, of women diagnosed with endometriosis, about 40 percent experience fertility challenges. Many women struggling with infertility remain undiagnosed; others won’t be diagnosed with endometriosis until they start to experience problems conceiving. It falls to ob-gyns to reverse this trend, particularly as 63 percent of general practitioners feel uncomfortable diagnosing and treating patients with endometriosis, and as many as half are unfamiliar with the three main symptoms of the disease.

Early endometriosis diagnosis and treatment lead to better outcomes. Careful listening and discussion are integral to early detection, as many common symptoms are not so obvious, such as chronic lower back pain and intestinal problems like diarrhea, constipation, bloating and nausea. We can also look for indicators that a woman is at greater risk of having endometriosis, including if she’s in her 30s and 40s; has a close relative who has been diagnosed with endometriosis (which increases risk by five to seven times); and has a higher body mass index (which is thought to promote the development of endometriosis because fat increases estrogen levels).

Raising awareness about endometriosis and increasing its timely diagnosis improves women’s lives. While symptoms may range in terms of severity, nearly all of them take a physical toll on a woman’s day-to-day life—from increasing tiredness to limiting her physical capabilities. It’s time to talk with our patients more regularly about endometriosis, and ensure more women are getting the care and support they need.

OB-GYN’s Crucial Role in Protecting Women from Cervical Cancer

Every year, more than 12,000 American women are diagnosed with cervical cancer, and more than 4,000 of those women die from the disease. And, according to a reevaluation of existing data in a study recently published in the journal Cancer, the cervical cancer death rate may actually be much higher than previously estimated. Since January is Cervical Cancer Awareness Month, now is an excellent time to educate our patients about the steps they can take to not become a part of these terrible statistics.

We know Pap smears are one of the most effective tools we have to improve cervical cancer outcomes. Half of all cases of cervical cancer occur in women between the ages of 35 and 55; it’s rarely found in women under 20, and about 20 percent of cases are in women 65 and older. That’s why we recommend regular cervical cancer screenings in our patients starting at the age of 21 and through the age of 65 or longer based on individual risk factors. Pap smears screen for a cancer that’s often symptomless, and they help spot changes in the cervix before cancer develops—when treatments are most effective. Due to widespread adherence to Pap smear testing, deaths from cervical cancer have decreased by 50 percent over the last 30 years. So, encourage your patients to attend their annual well-woman visits. Along with the opportunity to offer Pap smears and screenings, these visits provide an ideal occasion to educate patients about cervical cancer risks and prevention.

Of course, virtually all cervical cancer cases are linked to HPV. HPV is the most common sexually transmitted infection: 80 percent of all sexually active people will contract the virus in their lifetimes. A family history of cervical cancer increases the risk two- to three-fold, since these women may have a genetically inherited condition that makes it harder for their bodies to fight off HPV infection. The three-dose HPV vaccine protects against 81 percent of cervical cancer cases. The CDC, AAP, AAFP and ACOG all recommend the vaccine for boys and girls between the ages of 11 to 12 years old. Full vaccination reduces risk of certain HPV-related cancer by up to 99 percent; boosting vaccination rates could prevent 29,000 HPV-related cases of cervical cancer every year.

Vaccine adherence rates, however, remain low, with only about one-third of girls and just over one in 10 boys receiving their full vaccination series. Educating your young patients or those who are parents of preteen children is important. Likewise, it’s important to ask your patients in their teens and 20s whether or not they’ve been vaccinated. Even if a patient missed the recommended vaccine as a child and is sexually active, if she’s under the age of 27, it may still be beneficial because there may not have been exposure to all of the virus strains the vaccine protects against. If a patient refuses vaccination at first, it never hurts to keep offering it at future visits.

Like many things we discuss with our patients, there is still a lot of misunderstanding about HPV and cervical cancer.  That’s why it’s so important to continue to encourage annual well woman visits and HPV vaccinations. For more information to help guide your conversations with patients, visit ACOG’s Immunization for Women website, shotbyshot.org, or the National Cervical Cancer Coalitions Cervical Cancer Awareness Month page.

“The greatest reward for doing is the opportunity to do more.”

Tom Gellhaus, MD ACOG's 67th President

Tom Gellhaus, MD
ACOG’s 67th President

“The greatest reward for doing is the opportunity to do more.” ~Jonas Salk

This past Tuesday I was awarded a great opportunity to do more: I became ACOG’s 67th President. As the nation’s leading group of physicians providing health care for women, we have an unprecedented opportunity to do more and be empowered to make a difference in health care.

When I began my presidency, I ventured that we can make a difference in the next generation of health care through three main initiatives: global health, advocacy and new resident education models.

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Guest Blog: Lady Ganga and the Fight to End Women’s Cancers

Larry Maxwell, MD, FACOG, COL(ret) U.S. Army, Director of the Globe-athon to End Women’s Cancers

Global statistics from the International Agency for Research on Cancer indicate that in 2012, gynecologic cancers accounted for 16% of the 6.6 million estimated new cases and 14% of the 3.5 million cancer related deaths among women. That means that 1 million women will be diagnosed this year with cancers below the belt and a woman will lose her battle with this disease almost every minute of every day. Cervical cancer accounted for 527,000 new cases and for 239,000 deaths. Although cervical cancer is the fourth-leading cause of cancer related death across the globe, it is the number one cause of cancer related deaths in some parts of Africa. Prevention of cervical cancer with the HPV vaccine is one of the best strategies to address the increasing problem of cervical cancer, particularly for low income countries. Unfortunately, only one third of eligible girls have received all 3 doses of the HPV vaccine in the U.S. This lack of compliance is increased among underserved groups such as African Americans. Public mistrust of the HPV vaccine has been fueled by information that is often misleading. The Vaccine Adverse Events Reporting System, a national database maintained by the CDC, has analyzed severe events and not found any causative relationships. In order to optimize public opinion and enhance compliance, it’s important to clarify additional misperceptions about the safety of the vaccine.

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Adults Need Vaccines, Too!

ACOG Celebrates National Immunization Awareness Month

Every year, thousands of adults in the United States suffer serious health problems, are hospitalized, or even die from diseases that could have been prevented by vaccination. To celebrate the importance of immunizations throughout life – and to help remind adults that they need vaccines, too – ACOG is recognizing August as National Immunization Awareness Month. This is the perfect opportunity to make sure adults are protected against diseases like whooping cough, tetanus, shingles and pneumococcal disease. Let’s not forget the flu either, as flu season is right around the corner!

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For the Times They Are A-Changin’

Come gather ’round people…  

…If your time to you’s worth savin’  

Then you better start swimmin’ or you’ll sink like a stone  

For the times they are a-changin’ ~Bob Dylan

I began my ACOG Presidency this past Wednesday by reciting some of Bob Dylan’s famous verse from the 1960’s. It rings true today, especially in medicine and our specialty as obstetrician-gynecologists.

As the times change I thank our now past-president, Dr. John Jennings, for his leadership and friendship during this past year. With the counsel of his past president, Dr. Jeanne Conry, John tackled some of the very difficult issues facing our practices and our workforce. I will continue his fine work and advance it on behalf of our patients, our specialty and our organization, ACOG.

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Million Women March for Endometriosis—Making a Difference!

I am energized to have represented ACOG today at the first Million Women March for Endometriosis. ACOG is a proud co-sponsor of this important event to raise awareness of this debilitating and painful gynecologic condition.

It was an honor to have spent the day with dedicated physicians and most importantly, the women, girls, and their families and friends who are affected by endometriosis and were here to march on the National Mall today in Washington, DC.

Together, we CAN make a difference.

Dr. Conry behind the scenes at EndoMarch 2014 with Drs. Ceana (left) and Camran Nezhat, two of EndoMarch's sponsors.

Dr. Conry behind the scenes at EndoMarch 2014 with Drs. Ceana (left) and Camran Nezhat, two of EndoMarch’s sponsors.

Excited despite the cold! Dr. Conry with Linda C. Giudice, MD, PhD, Immediate Past President of the American Society for Reproductive Medicine, and Marc R. Laufer, MD, Chief, Division of Gynecology at Boston Children's Hospital.

Excited despite the cold! Dr. Conry with Linda C. Giudice, MD, PhD, Immediate Past President of the American Society for Reproductive Medicine, and Marc R. Laufer, MD, Chief, Division of Gynecology at Boston Children’s Hospital.

Community Walks Take Public Health Messages to the Streets

Last week, I walked one mile on my lunch hour. That may not seem like much exercise, but it certainly inspired me! Why? Because it was a community walk, in downtown Sacramento that started at the farmer’s market near our state capitol. Talk about messages on health—fresh food, fresh air, and exercise—this walk has it all. Each week, physician volunteers are invited to lead folks in a one-mile walk, answer questions, and reinforce health messages all in the shadow of our state capitol during lunch hour so that many state employees can participate. I know that I have pointed out that we are leaders in so many ways, and I really think this captures it. As physicians, we can lead in our hospitals, in our office practices, certainly through ACOG, but it is also great to look for community opportunities to get health messages out there.

Roughly 200 people attended our walk. They are my inspiration. I reminded them about the benefits of exercise: reducing their risk for heart disease, breast cancer, and colon cancer and feeling better in general. Then I gave them my favorite acronym on staying FIT:

Frequency: Exercise FIVE days a week
Intensity: Exercise so you cannot walk and talk at the same time (I call it “huffy-puffy”)
Timing: Exercise for at least 30 minutes

The setting at the farmer’s market is fun because there are opportunities to reinforce the importance of eating healthy fresh fruits and vegetables, reducing exposure to pesticides, and taking a half hour a day to devote to exercise. For those not ready for 30 minutes, I often try the “10 Minutes for Me” Challenge. I ask a nonexerciser to take 10 minutes every single day for 30 days and walk, saying “I have 10 minutes for me” so that they set his or her priorities differently. At the end of 30 days, these once-nonexercisers get the message that it is more about time than energy, and they add another 10 minutes of walking. The goal is to get a nonexerciser up to 30 minutes a day within three months!

Thankfully, the temperature has not yet hit 100 degrees (it was ONLY 95 on the day of our walk). But these walks do not have to be limited by weather. We all have mall walking programs nearby, and we can encourage participation in those. There are some well-known programs in Maryland and Virginia that have had regular participants for over 20 years. Those seniors are enough to inspire anyone.

So, lace up you shoes and get out into the community. No matter where you live, your words and actions can make a difference.

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